Evaluation of demographic, radiological and intraoperative factors for assessment of postoperative pain and complications in surgical removal of impacted mandibular third molar: a prospective study / Evaluación de factores demográficos, radiológicos e intraoperatorios para la evaluación del dolor postoperatorio y las complicaciones en la extracción quirúrgica del tercer molar mandibular impactado: un estudio prospectivo

Third molars usually erupt within the age of 17 ­ 21years. Usually, due to the evolution of human jaws, the size is decreasing leading to the impacted tooth. An impacted tooth may lead to external resorption of the adjacent tooth, trismus, infection, etc. Many studies have been reported in the literature for evaluating the surgical difficulty and postoperative complications secondary to impacted third molars. This study includes a sample of 100 subjects evaluated for the surgical difficulty and postoperative complications. Various demographic, radiological, and intraoperative factors were evaluated which may lead to postoperative complications. Factors responsible for postoperative sequelae were also evaluated with complications. Postoperative pain after 4 hours and 7 days was assessed to mark the factors commonly responsible. Pain at 7th postoperative day was significant involving factors like fully impacted, horizontal impaction, level C, no/very little retromolar space, and root contact. Postoperative complications were not reported in this study.

Los terceros molares suelen erupcionar entre los 17 y los 21 años de edad. Por lo general, debido a la evolución de las mandíbulas humanas, el tamaño disminuye, lo que conduce al diente impactado. Un diente impactado puede conducir a la reabsorción externa del diente adyacente, trismo, infección, etc. Se han reportado muchos estudios en la literatura para evaluar la dificultad quirúrgica y las complicaciones postoperatorias secundarias a terceros molares impactados. Este estudio incluye una muestra de 100 sujetos evaluados por la dificultad quirúrgica y las complicaciones postoperatorias. Se evaluaron diversos factores demográficos, radiológicos e intraoperatorios que pueden conducir a complicaciones postoperatorias. También se evaluaron los factores responsables de las secuelas postoperatorias con las complicaciones. Se evaluó el dolor postoperatorio después de 4 horas y 7 días para marcar los factores comúnmente responsables. El dolor al séptimo día postoperatorio fue significativo e involucró factores como impacto total, impactación horizontal, nivel C, espacio retromolar nulo o muy pequeño y contacto con la raíz. En este estudio no se informaron complicaciones posoperatorias.

A Comparative Study of the Effect of Primary and Secondary Closure Technique Following Removal of Impacted Mandibular Third Molars

Introduction: Surgical removal of the impacted mandibularthird molar is one of the most frequently performed surgicalprocedures in oral and maxillofacial surgery. The purpose ofthis study was to compare the primary and secondary woundclosure after surgical removal of impacted mandibular thirdmolars by evaluating the extent of facial swelling, the severityof pain and degree of trismus.Material and Methods: A prospective, randomized,clinical trial was conducted in 80 patients. The patients wererandomly divided into two groups of 40 each. In Group 1:patients underwent primary closure of the wound and inGroup 2: patients underwent secondary closure of the wound.Postoperative pain, swelling, and trismus were evaluated onthe 2nd and 7th day postoperatively.Results: Statistically significant difference was observed forfacial swelling and trismus on 2nd postoperative days betweenboth groups. Postoperative pain was less in the secondaryclosure group.Conclusion: From the outcome of the above study we canconclude that the secondary wound closure technique has asignificant advantage over primary wound closure concerningswelling and trismus.

Transplante dentário autógeno: revisão de literatura e relato de caso clínico / Autogenous dental transplantation: literature review and clinical case report

Objetivo: o transplante dentário é uma técnica cirúrgica que consiste na movimentação cirúrgica de um dente, podendo ser vital ou tratado endodonticamente, o qual é submetido a uma avulsão do seu local de origem e implantado em outro alvéolo. Relato de caso: paciente do sexo masculino, 18 anos, normossistêmico, buscou atendimento no Serviço de Cirurgia e Traumatologia Bucomaxilofacial da Pontífica Universidade Católica do Rio Grande do Sul (PUCRS) apresentando cárie no dente 26. O plano de tratamento consistiu em realizar um autotransplante do dente 28 para o alvéolo do dente 26. Após 8 meses do transplante, o dente apresentava em boas condições periodontais avaliadas clinicamente e em exame radiográfico. Considerações finais: o transplante dentário autógeno pode ser uma opção viável para a substituição de molares ausentes ou com cáries extensas, como mostrado no presente caso clínico. (AU)

Objective: Dental transplantation is a surgical technique that consists of the surgical movement of an either vital or endodontically treated tooth, which is subjected to an avulsion from its place of origin and implanted in another socket. Case report: An 18-year-old male patient, normosystemic, attended the Oral and Maxillofacial Traumatology Surgery Service of PUCRS presenting a decayed tooth 26. The treatment plan consisted of the autotransplantation of tooth 28 to the alveolus of tooth 26. Eight months after the transplantation, the tooth presented satisfactory periodontal conditions by clinical and radiographic assessments. Final considerations: The autogenous dental transplantation may be a viable option for replacing absent molars or with extensive caries, as shown in the present clinical case. (AU)

Spontaneous bone regeneration after surgical extraction of a horizontally impacted mandibular third molar: a retrospective panoramic radiograph analysis / 대한악안면성형재건외과학회지

BACKGROUND: The mandibular third molar (M3) is typically the last permanent tooth to erupt because of insufficient space and thick soft tissues covering its surface. Problems such as alveolar bone loss, development of a periodontal pocket, exposure of cementum, gingival recession, and dental caries can be found in the adjacent second molars (M2) following M3 extraction. The specific aims of the study were to assess the amount and rate of bone regeneration on the distal surface of M2 and to evaluate the aspects of bone regeneration in terms of varying degree of impaction. METHODS: Four series of panoramic radiographic images were obtained from the selected cases, including images from the first visit, immediately after extraction, 6 weeks, and 6 months after extraction. ImageJ software® (NIH, USA) was used to measure linear distance from the region of interest to the distal root of the adjacent M2. Radiographic infrabony defect (RID) values were calculated from the measured radiographic bone height and cementoenamel junction with distortion compensation. Repeated measures of analysis of variance and one-way analysis of variance were conducted to analyze the statistical significant difference between RID and time, and a Spearman correlation test was conducted to assess the relationship between Pederson’s difficulty index (DI) and RID. RESULTS: A large RID (> 6 mm) can be reduced gradually and consistently over time. More than half of the samples recovered nearly to their normal healthy condition (RID ≤ 3 mm) by the 6-month follow-up. DI affected the first 6 weeks of post-extraction period and only showed a significant positive correlation with respect to the difference between baseline and final RID. CONCLUSIONS: Additional treatments on M2 for a minimum of 6 months after an M3 extraction could be recommended. Although DI may affect bone regeneration during the early healing period, further study is required to elucidate any possible factors associated with the healing process. The DI does not cause any long-term adverse effects on bone regeneration after surgical extraction.

Comparison of the efficacy of amoxicillin-clavulanic acid with metronidazole to azithromycin with metronidazole after surgical removal of impacted lower third molar to prevent infection

OBJECTIVES: The goal of the study was to investigate the clinical effects of amoxicillin-clavulanic acid (500+125 mg) with metronidazole 400 mg administered three times daily (Group I) versus azithromycin 500 mg administered once daily and with metronidazole 400 mg three times daily (Group II) for the prevention of postoperative infection following mandibular third molar surgical removal. MATERIALS AND METHODS: The study design was a single-center prospective study. Patients who reported to the Department of Oral and Maxillofacial Surgery between February 2015 and January 2017 for removal of mandibular third molar were screened, and 108 patients were chosen. One surgeon carried out all procedures. Patients were prescribed antibiotics until the two groups contained a similar number of cases. RESULTS: Our data showed that Group II had fewer incidences of surgical site infection, but with no statistical significance. CONCLUSION: Although both treatments are used routinely after removal of the mandibular third molar, neither is significantly better than the other.

Evaluation of 1211 third molars positions according to the Classification of Winter, Pell & Gregory / Evaluación de posiciones de 1211 terceros molares acorde a la Clasificación de Winter, Pell & Gregory

Panoramic radiographs are important for the evaluation and classification of the third molars position, allowing the diagnosis and planning of extraction. The objective of this study is to evaluate upper and lower third molars positions in panoramic radiographs with the classification methods proposed by Pell and Gregory (1933) and Winter (1926) and the subsequent comparison of results with other authors. Panoramic radiographs of 310 patients were analyzed, 197 female and 113 male, totaling 1,211 third molars. In relation to the upper third molars, the most prevalent positions were: angle compared to the long axis of the second molar of Distoangular form (53.23 %) and the depth of impaction as Class C (48.25 %). In the lower third molars, the most prevalent positions were: angle to the long axis of the second molar in Mesioangular classification (52.96 %), the depth of impaction was B (46.54 %) and the tooth relationship with the mandibular ramus was identified as class I (55.26 %). These results provide information that can be utilized in predicting third molar development in terms of impaction or eruption, assisting dental surgeons in making decisions regarding surgical planning and treatment.

Las radiografías panorámicas son importantes para la evaluación y clasificación de la posición de los terceros molares, lo que permite el diagnóstico y la planificación de la extracción. El objetivo de este estudio fue evaluar terceros molares superiores e inferiores y posiciones en las radiografías panorámicas con los métodos de clasificación propuestas por Pell & Gregory, y Winter y la posterior comparación de los resultados con otros autores. Se analizaron las radiografías panorámicas de 310 pacientes, 197 mujeres y 113 hombres, con un total de 1.211 terceros molares. En relación con los terceros molares superiores, las posiciones más prevalentes fueron: ángulo con respecto al eje longitudinal del segundo molar de forma distoangular (53,23 %) y la profundidad de la impactación como Clase C (48,25 %). En los terceros molares inferiores, las posiciones más prevalentes fueron: ángulo con respecto al eje longitudinal del segundo molar en la clasificación mesioangular (52,96 %), la profundidad de impactación fue de B (46,54 %) y la relación de los dientes con la rama mandibular fue identificado como Clase I (55,26 %). Estos resultados proporcionan información que puede ser utilizada para predecir el desarrollo del tercer molar en términos de compactación o erupción, ayudando a los cirujanos dentistas en la toma de decisiones respecto a la planificación y el tratamiento quirúrgico.

Cementoblastoma a Rare Odontogenic Tumor - A Case Report and Differential Diagnosis.

Cementoblastoma is a rare odontogenic tumor derived from the odontogenic mesenchymal tissues. It has distinct clinical, radiographical, and histological features that aid in correct diagnosis. This article presented a case of 35-year-old female patient with pain and swelling in the right cheek region. Radiographic examination was suggestive of benign cementoblastoma in relation to unerupted right maxillary third molar. The tumor was surgically removed along with tooth, and the diagnosis of cementoblastoma was confirmed by histopathology examination.

The follow-up observation of an impacted molar adjacent to implant:A case report / 实用口腔医学杂志

A patient was treated by multiple dental implants,the implanted 6 was adjucent to impacted 8 .Immediately after implanta-tion,4 month and 3 year after implantation the distace between 8 and 6 implant central line was 4.4,3.2 and 2.5 mm,the angle between 8 long axis and 6 implant central line was 42.3°,45.5°and 50.3°.Then 8 was extracted.

Minimal anchorage invasive extraction of horizontally impacted mandibular third molar: A case report / 实用口腔医学杂志

Horizontal impacted lower third molars are often adjacent to the inferior alveolar nerve,direct extraction may cause trauma and complications,the most serious complication is inferior alveolar nerve damage.This article reports one case of horizontal impacted lower third molar adjacent to the mandibular nerve canal,the molar was extracted by minimal anchorage pulling for 1 week and then removed smoothly.

Solitary Bone Cyst-A Case Report with Diagnostic Prospective

Solitary bone cyst is an uncommon non-epithelial lesion of the jaw bones. It was first defined by Lucas and Blum in 1929. It is classified as an intraosseous pseudocyst. They are asymptomatic and are usually seen during routine radiographical examination. According to the 2002 classification of the WHO, traumatic bone cysts are miscellaneous lesions. This report describes an 18-year-old female patient who had a solitary bone cyst in the posterior region of mandible associated with an impacted third molar.

Hemodynamic changes associated with a novel concentration of lidocaine HCl for impacted lower third molar surgery

BACKGROUND: The authors studied the hemodynamic effect influent by using the novel high concentration of lidocaine HCl for surgical removal impacted lower third molar. The objective of this study was to evaluate the hemodynamic change when using different concentrations of lidocaine in impacted lower third molar surgery. METHODS: Split mouth single blind study comprising 31 healthy patients with a mean age of 23 years (range 19-33 years). Subjects had symmetrically impacted lower third molars as observed on panoramic radiograph. Each participant required 2 surgical interventions by the same surgeon with a 3-week washout period washout period. The participants were alternately assigned one of two types of local anesthetic (left or right) for the first surgery, then the other type of anesthetic for the second surgery. One solution was 4% lidocaine with 1:100,000 epinephrine and the other was 2% lidocaine with 1:100,000 epinephrine. A standard IANB with 1.8 ml volume was used. Any requirement for additional anesthetic and patient pain intra-operation was recorded. Post-operatively, patient was instructed to fill in the patient report form for any adverse effect and local anesthetic preference in terms of intra-operative pain. This form was collected at the seven day follow up appointment. RESULTS: In the 4% lidocaine group, the heart rate increased during the first minute post-injection (P < 0.05). However, there was no significant change in arterial blood pressure during the operation. In the 2% lidocaine group, there was a significant increase in arterial blood pressure and heart rate in the first minute following injection for every procedure. When the hemodynamic changes in each group were compared, the 4% lidocaine group had significantly lower arterial blood pressure compared to the 2% lidocaine group following injection. Post-operatively, no adverse effects were observed by the operator and patient in either local anesthetic group. Patients reported less pain intra-operation in the 4% lidocaine group compared with the 2% lidocaine group (P < .05). CONCLUSIONS: Our results suggest that a 4% concentration of lidocaine HCl with 1:100,000 epinephrine has better clinical efficacy than 2% lidocaine HCl with 1:100,000 epinephrine when used for surgical extraction of lower third molars. Neither drug had any clinical adverse effects.

Hemodynamic changes associated with a novel concentration of lidocaine HCl for impacted lower third molar surgery

BACKGROUND: The authors studied the hemodynamic effect influent by using the novel high concentration of lidocaine HCl for surgical removal impacted lower third molar. The objective of this study was to evaluate the hemodynamic change when using different concentrations of lidocaine in impacted lower third molar surgery. METHODS: Split mouth single blind study comprising 31 healthy patients with a mean age of 23 years (range 19-33 years). Subjects had symmetrically impacted lower third molars as observed on panoramic radiograph. Each participant required 2 surgical interventions by the same surgeon with a 3-week washout period washout period. The participants were alternately assigned one of two types of local anesthetic (left or right) for the first surgery, then the other type of anesthetic for the second surgery. One solution was 4% lidocaine with 1:100,000 epinephrine and the other was 2% lidocaine with 1:100,000 epinephrine. A standard IANB with 1.8 ml volume was used. Any requirement for additional anesthetic and patient pain intra-operation was recorded. Post-operatively, patient was instructed to fill in the patient report form for any adverse effect and local anesthetic preference in terms of intra-operative pain. This form was collected at the seven day follow up appointment. RESULTS: In the 4% lidocaine group, the heart rate increased during the first minute post-injection (P < 0.05). However, there was no significant change in arterial blood pressure during the operation. In the 2% lidocaine group, there was a significant increase in arterial blood pressure and heart rate in the first minute following injection for every procedure. When the hemodynamic changes in each group were compared, the 4% lidocaine group had significantly lower arterial blood pressure compared to the 2% lidocaine group following injection. Post-operatively, no adverse effects were observed by the operator and patient in either local anesthetic group. Patients reported less pain intra-operation in the 4% lidocaine group compared with the 2% lidocaine group (P < .05). CONCLUSIONS: Our results suggest that a 4% concentration of lidocaine HCl with 1:100,000 epinephrine has better clinical efficacy than 2% lidocaine HCl with 1:100,000 epinephrine when used for surgical extraction of lower third molars. Neither drug had any clinical adverse effects.

Dentigerous cyst with an impacted third molar obliterating complete maxillary sinus.

Dentigerous cyst is the most commonly occurring odontogenic cyst after radicular cyst and accounts for 15% of all true cysts in the jaws. The cyst is more common in mandible than in maxilla. The dentigerous cyst is commonly associated with impacted mandibular third molars. In maxilla, the incidence is rare. Dentigerous cyst in maxillary sinus in association with an impacted third molar is an uncommon entity. We present a case of dentigerous cyst associated with an impacted third molar, completely obliterating the maxillary sinus in a 28-year-old female.

Keratocystic odontogenic tumor with impacted maxillary third molar involving the right maxillary antrum:An unusual case report.

The odontogenic keratocyst (OKC), first described by Phillipsen in 1956, has metamorphosized as a keratocystic odontogenic tumor (KCOT) as reported in WHO classification of head and neck tumors in 2005. KCOT is a benign intraosseous neoplasm of the jaw and its occurrence in maxilla is unusual and its appearance in maxillary antrum along with maxillary impacted third molar is very uncommon. This article reports a case of KCOT associated with impacted maxillary third molar in right maxillary antrum and describes its rare site of occurrence.

Odontoma complejo extenso asociado a tercer molar retenido en base de mandíbula: relato de caso clínico / Extensive complex odontoma associated with an unerupted third molar in the mandible base: case Report

Los odontomas son tumores odontogénicos mixtos, diferenciados según sus características anatómicas en odontoma compuesto y complejo. El odontoma complejo es el más raro y normalmente se presenta con un curso evolutivo asintomático, puede ocasionar retención, mal posición dentaria y el aumento de volumen local. La terapéutica incluye exéresis completa de lesión. La evaluación histológica es importante, debido a la rara posibilidad de tratarse de un odontoma ameloblástico. El presente trabajo presenta un caso de una paciente de 18 años, transferida por un odontólogo para la evaluación de una lesión en la mandíbula del lado derecho. En la imagen radiográfica panorámica, se observó un área extensa radiopaca irregular, de evolución indeterminada, con aproximadamente 5 centímetros de diámetro, en la región del cuerpo y ángulo mandibular derecho. El tercer molar inferior derecho retenido y orientado hacia la base de la mandíbula, circunscrito por un área radiolúcida y el segundo molar inferior derecho ausente. Al examen físico intrabucal, observamos una tumefacción dura a la palpación en la superficie lingual de esta región. El diagnóstico presuntivo fue de odontoma complejo y quiste dentígero envolviendo el tercer molar. El examen microscópico reveló la presencia de folículos pericoronarios envolviendo el diente tercero molar inferior derecho y, en el interior de la masa removida, presencia de conglomerado irregular de esmalte, dentina, cemento y tejido pulpar. El diagnóstico final fue de odontoma complejo. La paciente se encontraba en observación de 5 años, sin signos clínicos y radiográficos de recidiva

Odontomas are mixed tumors which can be divided into two types: the complex and the compound odontoma. Complex odontoma is rare, and usually presents an asymptomatic course, being able to cause dental impaction, wrong teeth position and local volume increase. Surgical treatment of these lesions consists of local removal and curettage. The microscopic evaluation is important, because of the possibility of an ameloblastic odontoma. We report a case of an 18-year-old woman with a lesion involving the right mandible. In panoramic radiography we observed an extensive irregular radiopaque area with unknown evolution and approximately 5cm of diameter, in molar mandible region. Teeth 48 impacted and displaced to the mandible base, involved for a radiolucid area and absence of 47 tooth. The previous diagnosis was complex odontoma and dentigerous cyst involving the third molar. The microscopic examination showed a dental follicle surrounding tooth 48 and in the removed mass, haphazard fashion with enamel, dentin, cementum and pulp. Final microscopical diagnosis was complex odontoma. The patient is being followed-up for five years and no clinical and radiological evidences of recurrence were found

The influence of the presence and impacted state of mandibular third molars on the incidence of mandibular condyle fracture